Heparin-induced thrombocytopenia and thrombosis syndrome: in vivo cross-reactivity with danaparoid and successful treatment with r-Hirudin

Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is an immu ne-mediated drug reaction that occurs 5-14 d after initiation of heparin th erapy and is a potentially life-threatening thrombotic complication. The an tibody-heparin-PF4 complexes cause platelet activation and generation of pl atelet microparticles. The need for anticoagulant treatment in asymptomatic thrombocytopenia. is uncertain. However, treatment is warranted In HITTS, as illustrated in the case reported here. Danaparoid, r-Hirudin and argatro ban are effective drugs. Danaparoid has a 10-50% in vitro cross-reactivity rate with the HIT antibodies, but has been proven to be clinically efficaci ous even in these cases, Here, we report a case of in vivo cross-reactivity with danaparoid, the patient showed an excellent recovery with r-Hirudin.